Urodynamic changes as a consequence of NDO can increase the risk of vesicoureteric reflux and kidney damage. NDO involves involuntary contractions of the detrusor muscle of the bladder during the filling phase, resulting in urinary urgency and incontinence. Vesicoureteric reflux (VUR) is the backflow of urine from the bladder up the ureters to the kidney.

People with VUR are believed to be more likely to get urinary tract infections (UTIs) involving the kidney tissue, which could cause permanent kidney damage. Current treatment options include surgery, surgery plus long-term antibiotics, long-term antibiotics alone and endoscopic correction.

Lead researcher, Pierre Denys, MD, Professor of Urology, Hôpital Raymond Poincaré, Paris, France and colleagues conducted a randomized, double-blind multi-centre placebo-controlled study, in 53 patients with neurogenic detrusor overactivity resulting from spinal cord injury and 6 patients from multiple sclerosis. The mean age was 41.2 years and 39% were female.

Following a 2-week screening period, 19 patients were randomized to receive Botox 300 U, 19 to Botox 200 U, and 21 to placebo. The researchers used cystopic guidance to deliver 30 injections of 1 mL evenly over the detrusor muscle, avoiding the base and trigone. A total of 57 patients completed the study.

Results show significant reductions from baseline (P < .05) in the number of daily UI episodes for males and females throughout the study with Botox treatments. Mean reductions ranged from 32% to 54% and 42% to 58% in the Botox 200 U and 300 U groups, respectively. No such significant reductions were recorded with placebo.

The reduction in episodes of UI was significant up to week 18 (P </= .049) for males (300 U) and significant at weeks 18 and 24 (P </= .043) for females (Botox 200 U and Botox 300 U).

The Botox groups showed a lower number of involuntary urine losses compared to placebo at weeks 2, 6, 12 in males receiving 300 U (P </= .039), and at weeks 18, 24 for females receiving 200 U (P </= .034). Dr. Denys, said the differences in significance of results at each time point might be due to fewer females than males participating in the study.

The results showed that Botox might be an important therapeutic option for improving neurogenic bladder management, and for reducing the risk of vesicoureteric reflux and preventing upper urinary tract deterioration and kidney damage, Dr. Denys concluded.


[Presentation title: Management of Neurogenic Bladder with Focal Administration of Botulinum Toxin A: Minimizing Risks Associated with Increased Detrusor Pressure. Poster 59]

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